Work on Unpaid Encounters with Insurance Balances
How can you track your practice’s insurance A/R, know where your money is, and make sure payers respond to your claims? Use the Unpaid Encounters worklist in the Insurance Balances tool to follow up on unpaid claims.
Draft Documentation: This article describes functionality in PCC 10.4, coming to pediatric practices in late 2025.
Contents
Open and Review the Unpaid Encounters Worklist
To review encounters with unpaid insurance balances, open the Unpaid Encounters worklist in the Insurance Balances tool.
The Unpaid Encounters overview shows you total insurance balances, per-payor, aged from the date of service.
Double-click on a single insurance group or click “Work With All” to see all unpaid encounters with charges pending insurance.
On the Unpaid Encounters worklist, you can see… (columns explained) for each encounter.
You can filter the list to isolate the insurance A/R that you need to work on. For example, you could select an aging category to work on the oldest unpaid balances.
You can also filter by place of service or provider of service, and use columns to sort the results by date or other criteria.
By monitoring your practice’s insurance A/R on the Unpaid Encounters worklist, you can stay on top of your receivables and ensure that no claims slip through the cracks.
Troubleshoot a Specific Encounter
Double-click on an encounter to see more details.
The Unpaid Encounters – View Details screen provides information and tools that will help you review and resolve billing issues with the encounter.
The Encounter Details section summarizes basic billing information about the encounter. The Balance Information section lets you know how much was charged for the encounter and how much is still due.
If your practice has recorded any encounter billing notes for this encounter, they will appear as well.
Assign the Encounter, Set a Task, and Enter a Due Date
As you research the details of the encounter, you can optionally assign the encounter to a user, set a task, or enter a due date in order to followup on a billing issue later.
Back on the worklist, you can use filters, columns, and search to find encounters based on the assigned user, the task, or the due date.
View Full Encounter Details and the Encounter’s Claim History
To see all encounter details and the complete claim history, including ERAs or other communication from the payor, click “Billing History”.
On the Billing History for the encounter, you can review full charge and payment details. The Claim History shows you all insurance billing activity and includes links to review the payor acknowledgements and posted ERAs.
Review Patient Policies, the Complete Account History, and More
To review more information about the patient and the account, you can navigate to other sections of the chart. After clicking “Billing History”, click Patient Demographics to review insurance policies.
Or, to see the encounter in the context of other encounters for the family, click “Account History”.
By reviewing the full account history, you can see every event linked to each encounter and also understand the encounter in the context of the family’s billing record.
Review Eligibility for the Encounter’s Date of Service
If you want to check if there are eligibility records for the date of service, click “Edit Charges” and then “Patient Details” to see the eligibility component for that encounter.
If your practice confirmed eligibility for the patient, either automatically or manually, you can review the results and any comments added at the time.
Edit Encounter Details and Submit a New Claim
If you need to edit some aspect of the encounter or file a new claim, click “Edit Charges”.
You can change diagnosis and charge details, the responsibility party for each charge, and more.
After making changes, you can queue up a new claim. You can simultaneously add an Encounter Billing Note explaining what occurred.
Update the Encounter’s Task, User, and Due Date
After you submit an appeal, for example, you can optionally update the encounter’s status and add a due date for followup.
Back on the worklist, you can use filters, columns, and search to find encounters based on task, assigned user, or due date.